Geschlechtsdysphorie

M. Döhnert; A. Richter-Unruh; E. Herrmann

doi:10.1055/s-0038-1660973

Kinder- und Jugendmedizin, Table of Contents

Kinder- und Jugendmedizin 2018; 18(03): 190-198
DOI: 10.1055/s-0038-1660973

Endokrinologie

Schattauer GmbH

Geschlechtsdysphorie

Ein Überblick über die aktuelle Studienlage und die kontroverse Diskussion zur Hormontherapie im Kindes- und JugendalterGender Dysphoriascientific overview including controversial discussion of early pubertal suppression and cross-sex hormone therapy

Authors

M. Döhnert

¹Universitätsklinikum Leipzig – AöR, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters
A. Richter-Unruh

²Universitätsklinikum Münster, Klinik für Kinder- und Jugendmedizin
E. Herrmann

¹Universitätsklinikum Leipzig – AöR, Klinik und Poliklinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters

Abstract

Zusammenfassung

Kinder und Jugendliche mit Problemen bezüglich ihrer Geschlechtsidentität und Symptomen einer Geschlechtsdysphorie (GD) nehmen häufiger medizinische und psychologische Hilfe in Anspruch. Kinderärzte sind oft die ersten professionellen Helfer, die mit dieser Problematik konfrontiert werden. Der Übersichtsartikel befasst sich mit dem aktuellen Stand der Forschung zu diesem Thema und leitlinienorientierten Handlungsempfehlungen. Es wird eine multiprofessionelle Betreuung durch Kinder- und Jugendpsychiater, Kinder- und Jugendlichenpsychotherapeuten und pädiatrische Endokrinologen empfohlen. Die Entscheidung zu einer früh einsetzenden hormonellen Behandlung wird kontrovers diskutiert und bedarf einer gewissenhaften individuellen Entscheidung im Behandlungsteam.

Summary

Children and adolescents who suffering from gender identity disorder and gender dysphoria more often seek medical and psychological care. General pediatricians are often the first point of contact with the health care system. The objective of this overview is to provide the state of the art and existing clinical guidelines for gender nonconforming youth. Guidelines emphasize a multi-disciplinary approach with collaborators of mental health and medical providers with specialized knowledge about pediatric endocrinology. Early hormonal treatment needs a careful process of decision-making considering the scientific controversy and the individual case characteristics.

Schlüsselwörter

Geschlechtsdysphorie - Geschlechtsidentitätsstörung - Hormonbehandlung - Pubertätshemmung

Keywords

Gender nonconforming - transgender - gender identity - gender dysphoria - cross-sex hormones - pubertal suppression

Full Text

References

Literatur
1 Achenbach TM. Manual for the Child Behavior Checklist/4–18 and 1991 profile. Burlington VT: Dept of Psychiatry University of Vermont; 1991
2 Arcelus J, Bouman WP, van Den Noortgate W. et al. Systematic review and meta-analysis of prevalence studies in transsexualism. Eur Psychiatry 2015; 30: 807-815.
3 Burke SM, Cohen-Kettenis PT, Veltman DJ. et al. Hypothalamic response to the chemo-signal androstadienone in gender dysphoric children and adolescents. Front Endocrinol (Lausanne) 2014; 05: 60.
4 Clark TC, Lucassen MFG, Bullen P. et al. The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth’12). J Adolesc Health 2014; 55: 93-99.
5 Colizzi M, Costa R, Scaramuzzi F. et al. Concomitant psychiatric problems and hormonal treatment induced metabolic syndrome in gender dysphoria individuals: a 2 year follow-up study. J Psychosom Res 2015; 78: 399-406.
6 Costa R, Carmichael P, Colizzi M. To treat or not to treat: puberty suppression in childhood-onset gender dysphoria. Nat Rev Urol 2016; 13: 456-462.
7 Costa R, Dunsford M, Skagerberg E. et al. Psychological Support, Puberty Suppression, and Psychosocial Functioning in Adolescents with Gender Dysphoria. J Sex Med 2015; 12: 2206-2214.
8 de Vries ALC, Cohen-Kettenis PT. Clinical management of gender dysphoria in children and adolescents: the Dutch approach. J Homosex 2012; 59: 301-320.
9 de Vries ALC, Klink D, Cohen-Kettenis PT. What the Primary Care Pediatrician Needs to Know About Gender Incongruence and Gender Dysphoria in Children and Adolescents. Pediatr Clin North Am 2016; 63: 1121-1135.
10 de Vries ALC, McGuire JK, Steensma TD. et al. Young adult psychological outcome after puberty suppression and gender reassignment. Pediatrics 2014; 134: 696-704.
11 de Vries ALC, Steensma TD, Doreleijers TAH, Cohen-Kettenis PT. Puberty suppression in adolescents with gender identity disorder: a prospective follow-up study. J Sex Med 2011; 08: 2276-2283.
12 Delemarre-van de Waal HA, Cohen-Kettenis PT. Clinical management of gender identity disorder in adolescents: A protocol on psychological and paediatric endocrinology aspects. European Journal of Endocrinology 2006; 155 (Suppl. 01) S131-S137.
13 Drummond KD, Bradley SJ, Peterson-Badali M, Zucker KJ. A follow-up study of girls with gender identity disorder. Dev Psychol 2008; 44: 34-45.
14 Ehrensaft D. From gender identity disorder to gender identity creativity: true gender self child therapy. J Homosex 2012; 59: 337-356.
15 Ehrensaft D. Gender nonconforming youth: current perspectives. Adolesc Health Med Ther 2017; 08: 57-67.
16 Green R, Roberts CW, Williams K. et al. Specific cross-gender behaviour in boyhood and later homosexual orientation. Br J Psychiatry 1987; 151: 84-88.
17 Hare L, Bernard P, Sánchez FJ. et al. Androgen receptor repeat length polymorphism associated with male-to-female transsexualism. Biol Psychiatry 2009; 65: 93-96.
18 Hembree WC, Cohen-Kettenis PT, Gooren L. et al. Endocrine Treatment of Gender-Dysphoric/ Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2017; 102: 3869-3903.
19 Hoekzema E, Schagen SEE, Kreukels BPC. et al. Regional volumes and spatial volumetric distribution of gray matter in the gender dysphoric brain. Psychoneuroendocrinology 2015; 55: 59-71.
20 Klink D, Caris M, Heijboer A. et al. Bone mass in young adulthood following gonadotropin-releasing hormone analog treatment and cross-sex hormone treatment in adolescents with gender dysphoria. J Clin Endocrinol Metab 2015; 100: E270-275.
21 Korte A. Geschlechtsdysphorie und Störungen der Geschlechtsidentität bei Kindern und Jugendlichen. Frauenheilkunde up2date 2016; 10: 163-182.
22 Korte A, Beier KM, Vukorepa J. et al. Heterogenität von Geschlechtsidentitätsstörungen bei Jugendlichen: Zur differenziellen Bedeutung der psychiatrischen Komorbidität und individuellen Psychodynamik. Prax Kinderpsychol Kinderpsychiatr 2014; 63: 523-541.
23 Korte A, Lehmkuhl U, Goecker D. et al. Gender identity disorders in childhood and adolescence: currently debated concepts and treatment strategies. Dtsch Arztebl Int 2008; 105: 834-841.
24 Korte A. Geschlechtsidentitätsstörungen (Genderdysphorie) und deren Behandlung im Kindes- und Jugendalter. In: Stalla GK, Auer M, Augstein MS. (eds). Therapieleitfaden Transsexualität. 2. Aufl. Bremen: UNI-MED-Verl; 2015. (UNI-MED SCIENCE).
25 Kraemer B, Noll T, Delsignore A. et al. Finger length ratio (2D:4D) and dimensions of sexual orientation. Neuropsychobiology 2006; 53: 210-214.
26 Meyenburg B, Korte A, Möller B, Romer G. Störungen der Geschlechtsidentität im Kindesund Jugendalter (F64). Prax Kinderpsychol Kinderpsychiatr 2014; 63: 542-552.
27 Nuruddin S, Bruchhage M, Ropstad E. et al. Effects of peripubertal gonadotropin-releasing hormone agonist on brain development in sheep – a magnetic resonance imaging study. Psychoneuroendocrinology 2013; 38: 1994-2002.
28 Peters M, Manning JT, Reimers S. The effects of sex, sexual orientation, and digit ratio (2D:4D) on mental rotation performance. Arch Sex Behav 2007; 36: 251-260.
29 Quindeau I. Geschlechtsidentitätsentwicklung jenseits starrer Zweigeschlechtlichkeit. Prax Kinderpsychol Kinderpsychiatr 2014; 63: 437-448.
30 Ruble DN, Martin CL, Berenbaum SA. Gender Development. In: Damon W, Lerner RM. Eisenberg N. Handbook of Child Psychology. Volume 3 Hoboken: John Wiley & Sons; 2006: 858-932.
31 Schagen SEE, Cohen-Kettenis PT, Delemarre-van de Waal HA, Hannema SE. Efficacy and Safety of Gonadotropin-Releasing Hormone Agonist Treatment to Suppress Puberty in Gender Dysphoric Adolescents. J Sex Med 2016; 13: 1125-1132.
32 Shields JP, Cohen R, Glassman JR. et al. Estimating population size and demographic characteristics of lesbian, gay, bisexual, and transgender youth in middle school. J Adolesc Health 2013; 52: 248-250.
33 Spack NP, Edwards-Leeper L, Feldman HA. et al. Children and adolescents with gender identity disorder referred to a pediatric medical center. Pediatrics 2012; 129: 418-425.
34 Steensma TD, Biemond R, Boer F. et al. Desisting and persisting gender dysphoria after childhood: a qualitative follow-up study. Clin Child Psychol Psychiatry 2011; 16: 499-516.
35 Steensma TD, Cohen-Kettenis PT. Gender transitioning before puberty? Arch Sex Behav. 2011; 40: 649-650.
36 Steensma TD, Kreukels BPC, de Vries ALC, Cohen-Kettenis PT. Gender identity development in adolescence. Horm Behav 2013; 64: 288-297.
37 Steensma TD, McGuire JK, Kreukels BPC. et al. Factors associated with desistence and persistence of childhood gender dysphoria: a quantitative follow-up study. J Am Acad Child Adolesc Psychiatry 2013; 52: 582-590.
38 Steensma TD, van der Ende J, Verhulst FC, Cohen-Kettenis PT. Gender variance in childhood and sexual orientation in adulthood: a prospective study. J Sex Med 2013; 10: 2723-2733.
39 The World Professional Association for Transgender Health (WPATH). Standards of Care for the Health of Transsexual, Transgender, and Gender Nonconforming People. 2011 Available from: URL: http://www.wpath.org.
40 Tyson P, Tyson RL, Hellmann R. (eds). Lehrbuch der psychoanalytischen Entwicklungspsychologie. 4. Aufl. Stuttgart: Kohlhammer; 2012
41 Vance SR, Ehrensaft D, Rosenthal SM. Psychological and medical care of gender nonconforming youth. Pediatrics 2014; 134: 1184-1192.
42 Wallien MSC, Cohen-Kettenis PT. Psychosexual outcome of gender-dysphoric children. J Am Acad Child Adolesc Psychiatry 2008; 47: 1413-1423.
43 Wallien MSC, Zucker KJ, Steensma TD. et al. 2D:4D finger-length ratios in children and adults with gender identity disorder. Horm Behav 2008; 54: 450-454.
44 Wood H, Sasaki S, Bradley SJ. et al. Patterns of referral to a gender identity service for children and adolescents (1976–2011): age, sex ratio, and sexual orientation. J Sex Marital Ther 2013; 39: 1-6.
45 Zhou JN, Hofman MA, Gooren LJ, Swaab DF. A sex difference in the human brain and its relation to transsexuality. Nature 1995; 378: 68-70.
46 Zucker KJ. Epidemiology of gender dysphoria and transgender identity. Sex Health 2017; 14: 404-411.
47 Zucker KJ, Bradley SJ. Gender identity disorder and psychosexual problems in children and adolescents. New York: Guilford Press; 1995